MEDICARE: JERRELL D BELL LVN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164X00000X	Licensed Vocational Nurse	336458	TX

General Provider Information

NPI Number	:	1558922542
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JERRELL D BELL LVN

Provider Business Mailing Address
First Line	:	PO BOX 7145
Second Line	:
City	:	LONGVIEW
State	:	TX
Zip	:	75607-7145
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1828 E SE LOOP 323 STE 101
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75701-8314
Country	:	US
Telephone Number	:	903-581-8881
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2019
Last Update Date	:	07/14/2019

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